Physiology and prospects of bimanual tracheoesophageal brass instrument play
Acta Otorhinolaryngologica Italica
Faculty of Dentistry (ACTA)
Faculty of Humanities (FGw)
Faculty of Medicine (AMC-UvA)
Amsterdam Center for Language and Communication (ACLC)
This study investigated whether trachea pressures during brass instrument play of laryngectomised patients are within the
range of those measured during tracheoesophageal voicing, and whether application of an automatic speaking valve can ‘free’
both hands to play a brass instrument. Objective assessment of voicing and music playing parameters was carried out in 2 laryngectomised
patients with a low-pressure indwelling voice-prosthesis able to play brass instruments (tenor horn and slide trombone): sound
pressure levels in dB, maximum phonation time in seconds and trachea pressures in mmHg; videofluoroscopy, stroboscopy and
digital high speed endoscopy to assess neoglottis vibration and opening. The dynamic range of the voice in the patients was
29 and 20 dB, and maximum phonation time was 22 and 19 sec, respectively; intratracheal pressures during voicing varied from
7 mmHg for the softest /a/ to 49 mmHg for the loudest /a/. For brass instrument play, the intratracheal pressures varied from
14 mmHg for the softest tone to 48 mmHg for the loudest tone. Imaging confirmed earlier findings that the neoglottis is closing
and vibrating during voicing and remains ‘open’ without vibrations during music play, indicating good neoglottis control and
innervation. From these objective measurements, we can conclude that trachea pressures during brass instrument play are within
physiological ranges for tracheoesophageal voicing with a low-pressure indwelling voice-prosthesis. Furthermore, it was shown
that application of a stable baseplate for retaining an automatic speaking valve and an additional customisable ‘neck brace’
makes bimanual play possible again.
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